LeMone & Burke Ch 30 - 32
2
� Right side-� Low oxygenation
� Low pressure
� Light workload
� Goes toward the lungs
� Left side� High oxygenation
� Thick walled high pressure
� Heavier workload
� Carries oxygenation
blood to organs
3
� CO = HR x SV� CO=cardiac output
� HR= heart rate
� SV= stroke volume
� Factors that affect SV:� HR
� Preload
� Afterload
� Contractility
4
� Other than physical assessment
� History
� Family History
� Genetic Risk
� Personal History
� Diet History
� Socioeconomic Status
5
Risk Factors
� Modifiable� HTN
� Diabetes
� Hyperlipidemia
� Cigarette smoking
� Obesity
� Physical inactivity
� Diet
� Nonmodifiable� Age
� Gender
� Genetic Factors
The text also discusses Metabolic Syndrome and Risk
factors unique to women on page 964
Risk Factors and Preventive
Measures for Cardiac Disorders
� Heart Failure
� Risk factors
� Coronary artery disease
� Cardiomyopathies
� Hypertension
� Congenital and valvular heart disease prevention
� Education regarding coronary artery disease and diabetes
� Focused physical assessment
� General appearance
� Integumentary system
� Color
� Temperature
� Extremities
� Blood pressure
� Edema
� Venous and arterial pulses
8
� Lab tests:
� CBC
� Serum electrolytes
� Mark cardiac damage
� Troponin
� CK-MB
� Myoglobin
9
10
� Chest x-ray
� Angiography
� Cardiac Catheterization
� ECG
� Nursing interventions???
11
� Clients often fear diseases r/t cardiovascular system
� Require good education, opportunity for client and family to voice concerns/fears
� Support groups
� Cardiac rehab referral
12
Chapter 32
Nursing Care of Clients with Cardiac
Disorders
Pathophysiology of Common Cardiac Disorders
� Heart Failure
� Pulmonary Edema
� Rheumatic Fever/Rheumatic Heart Disease
� Infective Endocarditis
� Myocarditis
� Pericarditis
Pathophysiology of Common Cardiac Disorders
Pathophysiology of Common Cardiac Disorders
� Right
� Peripheral edema
� Weight gain
� anorexia
� Left
� SOB
� Fatigue
� Crackles on auscultation of breath sounds
17
� Types of inflammatory diseases:
� Myocarditis
� Infective endocarditis
� Pericarditis
� Rheumatic Carditis
18
Risk Factors and PreventiveMeasures for Cardiac
Disorders� Myocarditis
� Risk factors are any thing that alters immune response
� Advanced age
� Malnutrition
� Alcohol use
� Immunosuppression
� Exposure to radiation
� Stress
Anatomy, Physiology, andFunctions of the Heart
� The Pericardium
� Double-layered fibroserous membrane surrounding the heart
� Anchors the heart to surrounding structures
� Space between layers is filled with pericardial fluid
� Lubricates heart muscle
� Helps to cushion the heart
Anatomy, Physiology, andFunctions of the Heart
� And infection of the endocardium
� Common in clients who abuse drugs, had valve replacements, systemic infections or structural cardiac defects
22
Risk Factors and PreventiveMeasures for Cardiac
Disorders
� Infective Endocarditis� Risk factors
� Congenital deformities
� Tissue damage due to ischemic disease
� Valve prosthesis
� Intravenous drug use
� Invasive catheters
� Dental procedures or poor dental health
� Recent heart surgery
� Prevention
� Education is key
� Prophylactic antibiotics
� Most common complication is heart failure� 50% have embolic complications due to vegetation
� Common to have clients with petechia and splinter hemorrhages
� Diagnosed with positive blood culture or echocardiogram
� Treat with antibiotics� Often need antibiotics before dental procedures
24
25
26
� Often follows a respiratory infection
� Often presents with pain in supine position releived by sitting or leaning forward
� May hear friction rub with stethoscope
� Treated with NSAIDS relieved within 48 hrs. depends on cause for further treatment
� Short term course of illness (2-6 weeks) for acute
� Chronic may require surgery
27
Pericardiocentesis
Risk Factors and PreventiveMeasures for Cardiac
Disorders� Rheumatic Fever and Rheumatic Heart Disease
� Risk factors
� Crowded living conditions
� Malnutrition
� Immunodeficiency
� Poor access to health care
� Genetic factor may be present
� Prevention
� Prompt identification, treatment
� Importance of finishing medications
� Clients who experience life threatening dysrhythmias may require surgical treatment for short or long-term management
� Small device with a long battery life (20 years or longer)
31
Coronary Circulation and Electrical Properties of the
Heart
Coronary Circulation and Electrical Properties of the
Heart
34
� Education
� Function
� Activity
� Failure
� Interference
� Site care
� LeMone Page 1012
35
Ultimately when the heart fails, the patient will have shock
Chapter 11 LeMone and Burke
Cellular Homoeostasis and Basic Hemodynamics
� Homeostatic regulation maintained primarily by cardiovascular system
� Four physiologic components
� Sufficient cardiac output
� Uncompromised vascular system
� Sufficient blood volume and blood pressure
� Tissues that are able to extract and use oxygen
Types of Shock
� Hypovolemic Shock� Affects all body systems
� Most common type of shock
� Cardiogenic Shock� Loss of pumping action of the heart
� Obstructive Shock� Impaired diastolic filling (pericardial tamponade, pneumothorax)
� Distributive Shock� Also known as vasogenic shock
Shock
� Hypovolemic
� Too little circulating blood causes decrease in MAP thus not meeting the body’s total need for oxygen
� Internal hemorrhage
� GI bleed
� External hemorrhage
� trauma
� Dehydration
Shock
� Cardiogenic
� Heart muscle is unhealthy or pumping is impaired
� Causes a decrease CO, afterload and reduces MAP
� This is seen with an MI
Shock
� Obstructive
� Affects the heart muscles ability to pump effectively
� The heart itself is normal however manifestations outside the heart affect filling or contraction� Cardiac tamponade
� Tension pneumothorax
� Pulmonary embolism
Shock
� Distributive
� Loss of sympathetic tone
� Vasodilation
� Leaky capillaries
� Spinal cord injury
� Sepsis
� Anaphylaxis
Interventions for Clients Shock
� Medications
� Inotropic: increases cardiac contractility
� Vasopressors: used to treat neurogenic, septic, or anaphylactic shock
� Opioids: used to treat pain
� Immunizations: tetanus prophylaxis
Shock
� Look at the patient
� Compensated vs uncompensated
� Blood pressure
� Urine output
� HR
� RR
� Mental status